[Amikacin photo]
KEY POINTS
- Amikacin is an aminoglycoside antibiotic that inhibits bacterial growth in susceptible organisms by interfering with bacterial protein synthesis
- Binds to 30S and 50S ribosomal subunits, resulting in a defective bacterial cell membrane
- Exhibit concentration-dependent bacterial killing (higher peak levels means more bacterial killing)
- Has activity against many organisms, including susceptible Pseudomonas aeruginosa
- Most commonly given intravenously
- Can be dosed multiple times per day, once daily or a few times per week IV
- For non-tuberculosis Mycobacteria infections, higher doses at extended intervals are sometimes used (e.g., up to 25mg/kg IV three times weekly)
- The general dosing range for daily IV amikacin is 7 to 14mg/kg
- Lower doses can usually be used for urinary tract infection, since the concentrations in the urine are so high
- Dosing is frequently done based upon ideal body weight, see resources below for dosing guidance
- Nephrotoxicity and ototoxicity are potential side effects
- Adjust doses & frequency for kidney impairment
- Monitoring drug levels is frequently indicated
- Can be dosed multiple times per day, once daily or a few times per week IV
- An inhaled liposomal amikacin product was FDA-approved October 1, 2018 and is called Arikayce
- The recommended dosage in adults is once daily oral inhalation of the contents of one 590 mg/8.4 mL vial
- Consider pre-treatment with bronchodilators
- Has only been studied for refractory MAC lung disease
- See Arikayce package insert here for more details
RESOURCES
- Amikacin IV Package Insert
- Arikayce Package Insert
- Jackson Memorial / University of Miami Antibiotic Dosing Card
- Nebraska Stewardship Program PK Training Content
- PK-PD Compass
- IDSA Practice Guidelines
- Surgical Prophylaxis Guidelines
- Review of Population PK for Amikacin in Critically Ill Patients (2017)
- Amikacin for ESBL+ UTI (2016)
- Systematic Review of Amikacin Therapeutic Drug Monitoring in Adults (2016)